Wound hematoma induced sciatic nerve palsy after total hip arthroplasty.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
K S Christensen
Publications and source records attributed to K S Christensen.
Forefoot transcutaneous oxygen tension at different leg positions in patients with peripheral vascular disease.
Transcutaneous oxygen tension (TcPo2) was measured on the forefoot of 150 limbs of 128 patients with different stages of peripheral vascular disease (PVD) and on 36 limbs of 18 healthy subjects in the sitting and supine position. The diagnostic value of TcPo2 measurements was tested and compared with indirect toe pressure measurements. TcPo2 measured in the supine position gives the best diagnostic discrimination between healthy controls and patients with PVD and between patients with different degrees of PVD. The median TcPo2 in patients with PVD and rest pain (severe PVD), patients with PVD without rest pain (moderate PVD) and control subjects was 12 mmHg (range 0-61), 50 mmHg (range 0-86), and 60 mmHg (range 35-78), respectively. In the supine position, 95% of the patients with severe PVD had TcPo2 values below 40 mmHg, as opposed to 28% of the patients with moderate PVD and 8% of the control subjects. TcPo2 below 40 mmHg measured on the forefoot in the supine position suggests severe ischaemia. The diagnostic value of TcPo2 measurement is comparable with that of toe systolic pressure measurement. As a diagnostic and quantitative non-invasive method of evaluating patients suspected of PVD, TcPo2 measurement is ideal as it is easy to perform, and does not cause discomfort.
Adult↗
Assessment of intermittent claudication by means of the transcutaneous oxygen tension exercise profile.
Transcutaneous oxygen tension was measured simultaneously on both feet during exercise (TcpO2 exercise profile) in patients with claudication. The following groups were studied: 1) 21 control subjects; 2) 25 patients with bilateral claudication of whom eight had unilateral predominance; 3) 40 patients with unilateral claudication. The control group showed no significant decrease in TcpO2 during exercise. Patients with bilateral claudication and unilateral predominance showed a significant decrease in the TcpO2 exercise profile of both feet (P less than 0.05), the decrease in the more affected leg being significantly greater than that of the less affected leg (P less than 0.05). In patients without unilateral predominance of claudication there was a slight, yet significant decrease in TcpO2 of both legs. Patients with unilateral claudication were classified into three groups based on a constant work load of 50 W, which provoked typical leg pain during exercise (group I: 0-2 min; group II: 2-4 min; group III: greater than 4 min). The decrease in the TcpO2 exercise profile was always significant on the symptomatic leg. In the asymptomatic leg TcpO2 did not decrease. The changes in TcpO2 relative to values at rest of the symptomatic leg showed significant differences after 1 min in groups I, II, and III (P less than 0.05). In conclusion, the TcpO2 exercise profile appears to be a suitable objective method by which the peripheral arterial insufficiency during exercise in patients with intermittent claudication can be quantified.
Adult↗
A model for prediction of failure in amputation of the lower limb.
A logistic regression analysis of eighteen variables in eighty-three lower limb amputations was performed in order to predict stump failure. Five variables were identified as having a significant effect on the logistic model: Age had an inverse relation to failure rate (p less than 0.005). This effect was mediated through a subgroup of 23 patients who had had a vascular operation (p less than 0.02), as this group had a higher failure rate and were younger than those without previous vascular surgery. Furthermore, the surgical experience (p less than 0.005) was of major importance for stump failure. Experienced surgeons had a failure rate of 2% while less experienced had a rate of 29% (p less than 0.001). In addition, it was confirmed that the higher the skin perfusion pressure (p less than 0.05) and the amputation level, (p less than 0.05) the better the healing. A model including "skin perfusion pressure," "previous vascular surgery," "amputation level" and "surgical experience" had a good predictive capability with a misclassification rate of 0.08-0.11. Therefore it is suggested that a logistic model including these variables could be a helpful tool to predict the risk of stump failure.
Adult↗
[Postoperative analgesia with morphine versus morphine and paracetamol. A double-blind clinically controlled study with a placebo].
The effect of paracetamol on the postoperative employment of morphine was investigated in a double-blind clinically controlled investigation with a placebo. The operations concerned were elective gynaecological laparotomies and hip replacements. During the first 60 hours postoperatively, the employment of morphine was reduced significantly in the patients who received paracetamol. Reductions of 16, 22 and 26% were concerned. The differences between the various types of operation were not significant. Patients for joint replacements who had been treated preoperatively with non-steroid anti-inflammatory preparations did not have any significantly greater consumption of morphine postoperatively but the reduction in consumption of morphine in the paracetamol group was significantly greater with a saving of 43%. Patients who had received treatment with morphine preparations preoperatively had significantly greater consumption of morphine postoperatively but the additive analgesic effect of paracetamol remained unchanged at approximately 25%.
Acetaminophen↗
The cerebral arterio-venous oxygen content differences (AVDO2) during halothane and neurolept anaesthesia in patients subjected to craniotomy.
In 20 patients subjected to craniotomy for supratentorial cerebral tumours, the haemodynamic changes during halothane and neurolept anaesthesia were evaluated by measuring mean arterial blood pressure (MABP) and cerebral arterio-venous oxygen content differences (AVDO2) repeatedly during the operation. Ten patients were given 0.5% halothane anaesthesia and ten patients neurolept anaesthesia. MABP, AVDO2 and PaCO2 were measured after induction of anaesthesia, before and after incision, after opening and closure of the dura, at the time of extubation and 1 h later. Concerning MABP and PaCO2, no significant difference between the two groups was found. In both groups an increase in MABP was observed after incision (P less than 0.01 in the neurolept group and P less than 0.05 in the halothane group) and in the neurolept group after extubation (P less than 0.01). In both groups a decrease in AVDO2 was observed after incision (P less than 0.01) and after extubation (P less than 0.01 in the neurolept group and P less than 0.05 in the halothane group). During the operation AVDO2 values were significantly higher in the neurolept group (P less than 0.05). The results indicate that even a moderate increase in MABP after incision during neuroanaesthesia affects AVDO2 values, suggesting an increase in cerebral blood flow. The study suggests that autoregulation of cerebral blood flow might be better preserved during neurolept anaesthesia. A state of hyperperfusion of the brain after extubation was unveiled in both groups.
Adult↗
Long posterior flap versus equal sagittal flaps in below-knee amputation for ischaemia.
We analysed the complication rate in 140 below-knee amputations in relation to surgical technique and the presence of diabetes. In all cases, the skin perfusion pressure was measured below the knee before operation to provide an objective evaluation of the microcirculation. In diabetic patients we found a significantly higher complication rate after using a long posterior flap than after equal sagittal flaps. No such difference could be demonstrated in non-diabetic patients. We suggest that the higher incidence of atherosclerotic lesions in the three major arteries below the knee in diabetic patients may account for the difference. We recommend the use of the sagittal technique for below-knee amputation in diabetic patients.
Amputation, Surgical↗
Selection of lower limb amputation level not aided by transcutaneous pO2 measurements.
The transcutaneous oxygen pressure measurements were evaluated as supplementary ones for predicting stump healing in 58 below-the-knee and 16 above-the-knee amputations; the lower level was selected if the skin perfusion pressure was greater than 30 mm Hg below the knee. The failure rates in below-the-knee and above-the-knee amputations were 17 and 25 percent, respectively, and unrelated to the transcutaneous oxygen pressure measured at the amputation level. We conclude that no further information is acquired by measuring transcutaneous oxygen pressure.
Amputation, Surgical↗
Transcutaneous oxygen tension exercise profile. A method for objectively assessing the results after reconstructive peripheral arterial surgery.
Transcutaneous oxygen tension during exercise (TcPo2 exercise profile) was measured on the foot in 10 patients before reconstructive vascular surgery and 9 and 18 months later. The preoperative TcPo2 exercise profiles were abnormal in all 10 patients. In 9 of the patients the reconstructions were successful. In these patients the TcPo2 exercise profiles reverted to normal. In a control group of six healthy persons no significant changes in TcPo2 were observed during the follow-up period of 18 months. The reproducibility determined as the total week-to-week variation of claudicants and controls was 8%. The TcPo2 exercise test is suitable for monitoring the patient after reconstructive surgery, because it is based exclusively on objective data is non-invasive and the measurements are reproducible.
Adult↗
Results of amputation for gangrene in diabetic and non-diabetic patients. Selection of amputation level using photoelectric measurements of skin-perfusion pressure.
Evaluation was done of 235 patients who had had 273 primary amputations for gangrene. Measurements of local skin-perfusion pressure or systolic blood pressure were made in 222 limbs (188 patients). For the other fifty-one limbs, for which no measurements of pressure were available, the surgeon elected to perform an above-the-knee amputation in nine of seventeen diabetic limbs and a below-the-knee amputation in eight. An above-the-knee amputation was selected by the surgeon for thirty-two of thirty-four non-diabetic limbs and a below-the-knee amputation, for two for which no measurements of pressure were available. Local skin-perfusion pressure was measured distal to the knee before amputation, using a standardized photoelectric technique in 203 limbs and systolic blood-pressure measurements in nineteen. Skin-perfusion pressure was also measured above the knee in seventy-six of the 222 limbs in which a pressure was determined below the knee. These measurements were made available to the surgeon for use as an adjuvant guide to clinical assessment in selecting the appropriate level of amputation. Seventy-four patients (ninety-two amputations) had diabetes and 114 patients (130 amputations) did not. The limbs of the diabetic patients had a significantly higher skin-perfusion pressure at the below-the-knee level (p less than 0.001) than did those of the non-diabetic patients. The ratios of below-the-knee to above-the-knee amputations for the diabetic and non-diabetic patients were 3.8 to one and 1.3 to one (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Transcutaneous oxygen tension during hemodialysis in uremic patients with reduced cutaneous blood perfusion.
Explore the source record for details and available documents.
Humans↗
[Vertical extension in the treatment of supracondylar fractures of the humerus in children].
Explore the source record for details and available documents.
Child↗
Lower limb transcutaneous oxygen tension during aortic bypass grafting.
Transcutaneous oxygen tension (tcPO2) was measured continuously at the foot of 10 patients during abdominal aortic bypass grafting. Median tcPO2 before surgery was 38.5 mmHg (range: 14-74 mmHg) increasing to 79.0 mmHg (range 44-104 mmHg) after insertion of the vascular prosthesis (p less than 0.01). Eight successful vascular reconstructions were correctly identified intraoperatively. One was correctly identified as failed and one was correctly identified as unchanged compared with the preoperative clinical status. Our results indicate that tcPO2-monitoring may contribute to quality assurance by intraoperative identification of failed or insufficient vascular reconstructions.
Adult↗
Systemic lupus erythematosus with rectal stenosis simulating tumour or diverticulosis. Case report.
A case of systemic lupus erythematosus (SLE) with focal involvement of the rectum is reported. The lesion roentgenologically resembled a malignant tumour and was resected. Histologic examination disclosed only typical SLE changes in a very restricted area, with the remaining gastrointestinal tract unaffected. This appears to be the first report of focal colitis as a complication of SLE. The case points the importance of suspecting symptoms from any organ system in patients with connective tissue disorders to be manifestations of that underlying pathology.
Adult↗
Transcutaneous oxygen tension measurement over the sacrum on various anti-decubitus mattresses.
Transcutaneous oxygen tension (tcPO2) was measured over the sacrum of 12 healthy, normal-weight volunteers positioned on five different mattresses. TcPO2 was lower (p less than 0.01) in those on a standard hospital mattress (median 0 mmHg), than in those on a sheep skin (median 22 mmHg), water mattress (median 33.5 mmHg), Spenco mattress (median 52.5 mmHg) or ripple air mattress (median 0/62 mmHg). The tcPO2 for the Spenco mattress was higher (p less than 0.01) than for sheep skin and for the water mattress. No significant difference was found in tcPO2 for the latter two named above. TcPO2 for the ripple air mattress alternated between 0, when inflated under the oxygen sensor, to about full oxygenation, when deflated. We believe that the ripple air mattress theoretically is the best mattress to prevent decubitus ulcers, but due to frequent mechanical failure of pump or mattress, the Spenco mattress is perhaps the best for practical use. Clinical comparative studies will be necessary to confirm that.
Adolescent↗
Inflatable splints: do they cause tissue ischaemia?
The effect of increasing pneumatic splint pressure on cutaneous oxygen tension measured transcutaneously (TcPO2) was investigated in 12 subjects. The mean initial TcPO2 was 70.6 mmHg. TcPO2 decreased linearly on increasing the pressure within the splint. TcPO2 became zero at a mean splint pressure of 28 mmHg. Second, three accepted methods used by the ambulance crew to assess inflation pressures of the splint were investigated and found to be unreliable. In the light of these findings the risk of ischaemic complications as a result of applying pneumatic splints to a fractured limb is discussed. We advocate a recommended maximum splint pressure of 15 mmHg and that the splint should be manufactured with a security blow-off valve set at 15 mmHg.
Adult↗
Pneumatic antishock garments (PASG): do they precipitate lower-extremity compartment syndromes?
Pneumatic antishock garments (PASG) are widely used for treatment of hypovolemic shock and for long-term control of bleeding associated with pelvic fractures. Several cases of compartment syndromes (CS) caused by PASG application, and with sequelae such as limb loss, myoglobinuric renal failure, and death have been reported. The aim of this study was to investigate the amount of PASG pressure needed to produce tissue anoxia. Twelve normotensive subjects were investigated, and transcutaneous oxygen tension (TcPO2) was measured beneath a full-length pneumatic splint at the following pressures applied: 0, 10, 15, 20, 25, 30, and 35 mm Hg. Without imposed pressure, mean TcPO2 was 70.6 mm Hg. TcPO2 decreased by increasing pneumatic pressure, expressed by the equation: TcPO2 = 2.3x + 65.7, where x is applied pressure in mm Hg. TcPO2 became zero at a mean applied pressure of 28 mm Hg (25-35). It is concluded that PASG pressures of 30 mm Hg or more applied to the whole limb stop microcirculation and result in tissue anoxia. Even low PASG pressures carry a high risk of precipitating CS. To avoid ischemic injury new guidelines for PASG application are discussed.
Adult↗
Transcutaneous oxygen measurement in peripheral occlusive disease. An indicator of wound healing in leg amputation.
In 42 amputations (28 below-knee and 14 above-knee), healing of the stump was found to correlate with the pre-operative transcutaneous oxygen pressure (tcPO2) measured at the planned site of incision. Of 31 patients with a tcPO2 of 30 mmHg or more, 27 healed primarily, three had delayed healing and one failed to heal; of seven patients with values between 20 and 30 mmHg three healed primarily and four had delayed healing; and all four patients with a value below 20 mmHg had stumps which failed to heal and needed reamputation. It is concluded that a tcPO2 of 20 mmHg or more at the intended site of amputation indicates that the wound will heal.
Adult↗